Pain FAQ

The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Pain is subjective in nature and is defined by the person experiencing it, and the medical community's understanding of chronic pain now includes the impact that the mind has in processing and interpreting pain signals.

What treatements are available for chronic pain?

Pain treatment begins with an assessment of the severity of the pain. Commonly, the first steps of treatment are rest, application of cold or heat and intake of OTC (over the counter) medication.

The next step in the treatment of pain is a combination of physical therapy and prescribed pain medication. It is important to note that sometimes, interventional pain management needs to be started prior to Physical Therapy in order to stop acute pain (i.e. acute radiculopathy) and allow the patient to comply with necessary exercise.

If prescribed pain medication and physical therapy don’t work, the next step is usually interventional pain management, unless the patient has acute loss of function or acute neurological deficit (in which case surgery is needed).

If interventional pain management doesn’t alleviate the pain, surgery might be required. However, even after surgery interventional pain management has a very important role in the treatment of patients, especially when all other options are exhausted (ex. “failed back surgery” syndrome).

Why am I experiencing pain?

Head and Neck Pain

The most common origins of head and neck pain are neurogenic (nerve root compression, peripheral neuropathy, herpetic neuralgia), soft tissue pain (cervical strain, myofascial pain), musculoskeletal pain (degenerative joint disease, fracture, neoplasm, degenerative disk disease), or sympathetic pain. Depending on pain origin, there are different treatment options.

Low Back Pain

Low back pain originates from any of four major structures: bone (degenerative joint disease, spinal stenos, facet arthropathy, metastatic malignancy), lumbar disk (herniated nucleus pulposus, degenerated ruptured disk), musculoskeletal system (muscles and ligaments strain, muscular spasm), and nerves (neuropatic pain).

One of the most difficult types of pain to treat is post-surgical arachnoiditis (failed back surgery syndrome). Up to 85% of patients with low back pain cannot be given a definitive diagnosis because of the poor association among symptoms, pathologic findings and imaging results.

Upper Back and Thoracic Pain

Although upper back pain and thoracic pain are not very common spinal disorders, they tend to result in significant discomfort and pain. Thoracic pain may be caused by internal organ pathology (lung cancer, esophageal disorders, heart disorders), referral pain (cardiac angina, cholecistitis), muscular irritation (myofascial pain), joint dysfunction of thoracic cage and upper back, pain from herniated or degenerated disk, nerve pain (intercostal neuralgia, herpes zoster), pain from osteoporotic vertebra body collapse.

Abdominal Pain

Abdominal pain is usually caused by disease of internal organs of the abdominal cavity and is treated by a gastroenterologist or surgeon. Interventional pain management is offered to patients who suffer from advanced cancer of internal organs (especially pancreatic cancer) or other chronic conditions (chronic pancreatitis, abdominal angina). Most of the time, treatment is very successful.

Chronic Pelvic Pain

Chronic pelvic pain may occur in the presence of known or suspected organic pathology, or without any evidence of an underlying physical cause. Pelvic pain is more common in women, with most common reasons being endometriosis, endometritis, pelvic inflammatory disease, pelvic adhesions, neoplasm, and myofascial pain of the pelvic floor muscles. Pelvic pain may persist even after total hysterectomy.

Central Pain

Central pain is produced by lesions of the central nervous system: spinal cord, brain and brainstem. An example of central pain are: multiple sclerosis, neoplasm, patients with stroke.

Peripheral Nervous System Pain

Peripheral nervous system pain ( peripheral neuropathy) results from peripheral nerve lesions. This peripheral nerve lesions may be caused by Herpes Zoster (postherpetic neuropathy), diabetes (diabetic neuropathy), entrapment neuropathy ( pain after inguinal hernia repair), chronic alcoholism (alcoholic neuropathy).

Reflex Sympathetic Dystrophy

Reflex Sympathetic Dystrophy (RSD), or Complex Regional Pain Syndrome (CRPS I), applies to a variety of seemingly unrelated disorders having similar clinical feature and manifesting the sane fundamental disturbed physiology. Causalgia or Complex Regional Pain Syndrome (CRPS II) is a historical term describing a RSD that follows partial or complete injury to peripheral nerve trunk. Pain is characterized by constant, spontaneous, severe burning pain. If persistent, it results in trophic changes.

Phantom Limb Pain

Phantom Limb Pain describes painful sensations that are perceived to originate in the amputated portion of extremity. In addition, patient may have localized pain following amputation, which originates from the stump itself.